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Law Educator, Esq.
Law Educator, Esq., Attorney
Category: Employment Law
Satisfied Customers: 117358
Experience:  20+ Years of Employment Law Experience
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I am a counselor who subcontracts and sees clients referred

Customer Question

I am a counselor who subcontracts and sees clients referred by a Psychologist. They do the billing and i am paid a %. I recently came across some billing forms to different insurance agencies including Medicaid and Medicare that were billed. The dates were correct for when I saw the clients but they had put a different diagnosis code for the billing than I diagnosed the client for. Then they signed my name and sent it in to be paid. It is not my signature. There is incorrect information on the form. I have come across dozens of these. When I confronted the owners they blew me off that I was making a big deal out of nothing and of course I told them It is a big deal that someone is signing my signature to a billing to an insurance company and it is not me.
Submitted: 2 years ago.
Category: Employment Law
Expert:  Law Educator, Esq. replied 2 years ago.
Thank you for your question. I look forward to working with you to provide you the information you are seeking for educational purposes only. This is considered insurance fraud and you need to report it to the state insurance commission and also to medicare/medicaid in writing. The reason you need to report it, especially for any government benefits, is that if they prove there was fraud, you are entitled to an award in the amount of the money that this person is found to have defrauded them out of (it is called a "qui tam action") and that is as a reward for reporting fraud and abuse of benefits. They cannot legally change diagnosis codes, dates nor sign your name to documents, that is considered to be fraudulent conduct. Also, if you do not report this, then the insurers and medicare/medicaid can come after you for fraud in addition to going after the biller.